Joint support and subchondral support system

ABSTRACT

A joint support and subchondral support system for providing structural and dampening support to damaged subchondral bone in generalized or discrete arthritis includes a contoured, porous plate having a variable shaped inner surface, outer surface, and peripheral surface of variable thickness extending between the inner surface and the outer surface, suitable for insertion within the subchondral bone. The inner surface, outer surface and peripheral surface each have a concave portion and a convex portion. A guide pin hole or slot is located within the contoured, porous plate to aid in insertion and placement of the plate over at least one corresponding guide pin within the subchondral bone. The joint support and subchondral support system of the present invention is applicable to many parts of the joint as any area with cartilage disease has an adjoining subchondral component.

Cartilage disease has been previously addressed by various means ofreplacing or substituting the damaged cartilage. Microfracture orabrasionplasty is a form of irritating exposed bone to createreplacement fibrocartilage, but the resultant material is inferior tonative cartilage. Osteochondral transplant replaces plugs of diseasedcartilage and accompanying subchondral bone with grafts from either thepatient or human cadaver. Small discrete lesions work well, but largerlesions, bipolar disease, and diffuse disease are not well addressed.Chondrocyte implantation harvests the patient's cartilage cells, growsthem, and re-implants them on the bony bed, and covers them with aperiosteal patch. Each of the aforementioned techniques work best forsmall contained lesions, unipolar defects (i.e., one side of joint), andprimarily femoral condyle lesions. Less optimal results occur withpatellofemoral joint disease, and tibial sided disease.

A further method of treating cartilage disease is to realign the jointwith an osteotomy. This relieves an overloaded compartment, transferringstress to a less diseased compartment. Success of this method involvesavoiding non-union and other complications, and requires prolongednon-weight bearing activity and eight to twelve months to realizeclinical benefits. Only patients with mostly unicompartmental diseaseare candidates. Osteotomy also complicates latter joint replacement.

Arthroscopy is used to treat other causes of pain from arthritis,namely, loose bodies, loose or frayed cartilage, meniscus tears, andsynovitis. These are temporizing measures.

The end stage of cartilage disease is to perform total jointreconstruction. This type of procedure presents a prolonged recoverytime and surgical risks. Because total joint prostheses are fabricatedof metal and plastic, revision surgery for worn-out components isfraught with much higher complications than primary surgery, and isinevitable if the patient lives much beyond ten years.

Not much is known about the cause and progression of arthritis. Withcurrent diagnostic techniques such as MRI and bone scintigraphy, morehas been elucidated about the disease process. In particular, thesubchondral bone plays an important role in the initiation andprogression of arthritis. Arthritis is a disease of not just thecartilage, but the underlying subchondral bone as well. Most of theclinical research to date is focused on cartilageregeneration/replacement and not on the underlying bone health.

Traditionally, cartilage has been viewed to be avascular, with diffusionof nutrients occurring from within the joint. Studies have confirmed,however, that subchondral bone is a source of vascular and nutritionalsupport for cartilage. With age, vascular and structural support fromthe subchondral bone diminishes, allowing arthritic disease to progress.Namely, the inability of the bone to adequately repair itself asincreasing damage occurs starts a cycle of further destruction,interfering with cartilage vascular supply and structural support.

As cartilage wear occurs, the primary functions of cartilage—to providea low-friction bearing surface and to transmit stresses to theunderlying bone—are diminished. Bone is most healthy when resistingcompressive stresses. The shear stresses from the joint are partiallyconverted to compression and tension via the architecture of thecartilage baseplate, the layer between the cartilage and underlying boneis undulating. Further, by virtue of the ultra low friction surface ofcartilage on cartilage (20× lower friction than ice on ice), shearstresses are mostly converted to longitudinal. The subchondral bone isthe predominant shock absorber of joint stress. Via its arch-likelattice-work of trabecular bone, stresses are transmitted to the outercortices and ultimately dissipated. Cartilage itself does very littleshock absorption secondary to its shear thickness and mechanicalproperties.

Bone is the ultimate shock absorber, with fracture being the endpoint offorce attenuation. Trabecular microfractures have been shown to occur inlocations of bone stress in impulsively loaded joints. Every joint has aphysiologic envelope of function—when this envelope of function isexceeded, the rate of damage exceeds the rate of repair. As cartilagedisease progresses, subchondral bone is less able to dissipate thestress it encounters, i.e., shear-type stresses. The attempts ofsubchondral bone to heal and remodel are seen as arthritisprogresses—osteophyte formation, subchondral sclerosis, cyst formation,and subchondral MRI-enhanced changes, and increased signal on bonescintigraphy. Joint deformity from these changes further increases jointreaction force. Cartilage homeostasis is compromised—structural,vascular, neural, and nutritional.

Clinical success of current cartilage surgery is limited as it generallyonly works for small, unipolar (one-sided joint) lesions of the femoralcondyle. No current treatment exists for bone edema or osteonecrosis ofthe knee.

It would be desirable to have a minimally invasive joint support andsubchondral support system that specifically addresses the subchondralbone in arthritic disease process and progression, and relieves the painthat results from diseased subchondral bone and the spectrum of symptomsthat result from arthritis, including pain, stiffness, swelling, anddiscomfort. It would be further desirable to have a joint support andsubchondral support system that provides as follows: (1) a treatmentspecifically for bone edema and bone bruises and osteonecrosis that haspreviously not existed; (2) structural scaffolding to assist in thereparative processes of diseased bone next to joints; (3) shockabsorbing enhancement to subchondral bone; (4) compressive, tensile, andespecially shear stress attenuation enhancement to subchondral bone; (5)a means to prevent further joint deformity from subchondral boneremodeling such as osteophyte formation; (6) assistance in the healingof or prevention of further destruction of overlying cartilage bymaintaining and allowing vascularity and nutritional support fromsubchondral bone; (7) assistance in the healing of or prevention offurther destruction of overlying cartilage by providing an adequatestructural base; (8) a minimally invasive alternative to total jointreconstruction that also does not preclude or further complicate jointreconstruction; (9) a treatment for subchondral bone disease in its rolein arthritis and delay or halt further progression; (10) an implant forarthritis that is minimally subject to loosening or wear, as it isintegral to the trabecular framework it supports; (11) an alternativefor tibial sided, patellofemoral, and bipolar disease (tibial-femoral)that is relatively easy to perform, as an adjunct to arthroscopy, and asan outpatient procedure with minimal downtime for the patient; (12) atreatment for arthritis that allows higher lever of activity than thatallowed after joint resurfacing or replacement; (13) a cost effectivealternative to joint replacement with less issues about the need forrevision and surgical morbidity, especially in countries with lessmedical resources; and (14) a treatment option in veterinary medicine,specifically in equine arthroses and arthritides.

SUMMARY OF THE INVENTION

The present invention provides a joint support and subchondral supportsystem or device for the treatment of damaged subchondral bone inarthritic disease process and progression. The present invention isdescribed herein for the human knee joint, but the device may apply toother joints and species. In a first aspect, the present inventionincludes a contoured, porous plate having a variable shaped innersurface, outer surface, and peripheral surface of variable thicknessextending between the inner surface and the outer surface, suitable forinsertion within the subchondral bone. The inner surface, outer surfaceand peripheral surface each have a concave portion and a convex portion.The geometry of the inner surface, outer surface, and peripheral surfacemay vary depending on the exact anatomic location being treated (i.e.,proximal tibia versus femoral trochlea) and the specific geometry of thelesion being treated. One to multiple guide pin holes or slots arelocated within the device to aid insertion. The guide pin(s) areinserted into the anatomic site initially with the device inserted overthe pin(s) via the holes or slots; the excess pin(s) may break away orbe removed after device is inserted within the subchondral bone.

The porosity of the contoured plate is within a range of from about 50microns to about 20 mm. The degree of porosity of the contoured platecan be microporous, scaffold-like pores, or fibrous matrix material. Thecontoured plate includes a plurality of surface dimpling thereon havinga radius of from about 50 microns to about 3 mm. The contoured platefurther includes a plurality of undersurface pimples thereon having aradius of from about 50 microns to about 3 mm.

The contoured, porous plate is configured to fit flush with at least onecontour of the corresponding subchondral bone at the specific bodylocation to be treated, or it may be of reverse, neutral or complexpolarity. The contoured plate may be inserted in at least two locationsof the subchondral bone as a modular or monobloc insert. At least twocontoured, porous plates may be placed anterior and posterior to eachother within the subchondral bone. The contoured, porous plate has across-sectional area of from about 1 mm² to about 100 cm². Theperipheral surface has a variable thickness of from about 0.1 mm toabout 5 cm. The central area of the plate may be of a thinner dimension,with a reverse taper to increase thickness peripherally.

The contoured, porous plate includes at least one active or passivedampening element. The materials which comprise the joint support andsubchondral support system are dampening, thereby enhancing thetrabecular bone's ability to withstand shock and shear stress. The jointsupport and subchondral support system is fabricated of a biocompatiblematerial, such as metals, metal alloys, carbon fibers, foam metals,ceramics, ceramic composites, elastomer composites, elastomer-carbonfiber composites, chambered or fluid-filled materials, metal matrices,injectable gels, injectable composites with fluid and solid matrices,bone or bone-composite or allografts, crystal or hydroxyapatitematerials, plastics (i.e., PEEK), polymers, bioabsorbable composites(i.e., TCP/PLLA), or combinations of the above materials.

In another aspect of the present invention, a joint support system forproviding structural and dampening support to damaged subchondral boneadjacent to a body joint includes an elongated plate having a pluralityof tapered strut elements of variable geometry and thickness oriented ina vertical configuration for insertion into the subchondral bone. Thestrut elements include a plurality of superior struts formed on an upperportion of the plate and a plurality of inferior struts formed on alower portion of the plate, wherein the plurality of inferior struts maybe configured to be out of plane with the plurality of superior struts.

The elongated plate may be inserted separately from the plurality ofstrut elements within the subchondral bone as a modular insert. Theplurality of strut elements has a porosity of at least one ofmicropores, scaffold-like pores, and fibrous matrix material. Theelongated plate may be releasably attached to the plurality of strutelements with smoothly rounded joint elements at each intersection ofthe strut elements and plate.

The plurality of strut elements has a geometry of at least one ofsinusoidal, parallel, radial, circular, curved, rectangular,trapezoidal, hexagonal, ocatagonal, cross-hatching, and cross-elements.The plurality of the superior and inferior struts have a width of fromabout 0.1 mm to about 10 mm and a height of from about 0.5 mm to about35 mm.

The plurality of superior struts has a primary bearing elementconfigured to be contoured such that the primary bearing element isgenerally the same as the corresponding subchondral bone being treated.The primary bearing element may include a flared bearing surface that issubstantially wider than each of the plurality of superior struts. Theflared bearing surface has a width of from about 1.1 to about 4× a widthof each of the plurality of superior struts. The plurality of superiorstruts may include at least one secondary bearing element that connectsthe plurality of superior struts to each other. At least one secondarybearing element has a width of from about 0.5 to about 5× the width ofthe superior strut. The primary and secondary bearing elements havesurface material properties, which allow an ultra-low coefficient offriction.

One to multiple guide pin holes or slots are located within the deviceto aid insertion. The guide pin(s) are inserted into the anatomic siteinitially with the device inserted over the pin(s) via the holes orslots; the excess pin(s) may break away or be removed after device isinserted within the subchondral bone.

The elongated plate and plurality of strut elements have at least oneactive or passive dampening element. The elongated plate and pluralityof strut elements are fabricated of a biocompatible material of the sametype as set forth in the prior embodiment.

In a further aspect of the present invention, a joint support andsubchondral support system for providing structural and dampeningsupport to damaged subchondral bone adjacent to a body joint, includes aplurality of vertical struts of variable geometry and thickness having afirst end and a second end, suitable for modular insertion within thesubchondral bone. The plurality of vertical struts further include abearing surface contoured to fit the subchondral bone being treated,wherein the bearing surface includes a primary bearing flare.

The device may have a porosity comprised of micropores, scaffold-likepores, or fibrous matrix material. The plurality of separate verticalstruts may have various cross-sectional shapes such as triangular (bothpolarities), smooth thermometer-like, trapezoid, flared diamond-shaped,oval, tapered with flared-diamond, and rectangular. At least one of theplurality of vertical struts first end and second end is tapered. Thebearing surface includes a secondary bearing flare extending below thebearing surface. The secondary bearing flare is at least one of ahorizontal wing strut and dimple.

The plurality of vertical struts are inserted in either a parallel orradial orientation within the subchondral bone. The plurality ofvertical struts have at least one active or passive dampening elementand are fabricated of a biocompatible material of the same type as setforth in the prior embodiments.

In still another aspect of the present invention, a joint support andsubchondral support system for providing structural and dampeningsupport to damaged subchondral bone adjacent to a body joint includes aprimary bearing strut element of variable geometry and thickness havinga longitudinal body and an inner edge and an outer edge, suitable forinsertion within the subchondral bone. The longitudinal body has aporosity to allow vascularity, bridging bone, and other biologicalelements to pass through. The inner edge is scalloped to penetrate thesubchondral bone during insertion. The outer edge has at least twogrooves formed therein an inner surface of the longitudinal body. Aninserter holder may be slidably disposed through at least two grooves atthe outer edge on the inner surface of the longitudinal body andextended past the inner edge during insertion of the strut elementwithin the subchondral bone. The basic shape of the primary bearingstrut element is a circle. The primary bearing strut elements may beconfigured to be joined to each other in the form of a geometric shapesuch as a multiple concentric circle, joined circles, hexagon, octagon,and other non-linear, non-euclidean shapes, such as a hexagon withsmooth edges.

Single or multiple geometric shapes may be configured to be joined toeach other in various patterns such that the geometric shapes maypenetrate the subchondral bone to be treated. The plurality of strutelements configured to be joined together include at least threeconnecting struts to form a multiple concentric circle in which eachcircle of joined together primary bearing strut elements is connected toan adjacent circle by the connecting struts. The primary bearing strutelements configured to be joined together in a geometric shape each havea diameter of from about 1 mm to about 5 cm and a height/depth of fromabout 1 mm to about 3 cm.

A bearing surface cover may be attached to the periphery of the outeredge of the primary bearing strut element to contain marrow contentsentering the treatment site via the vascular channels or exogenoussubstances injected through the cover. The bearing surface cover may befabricated of either a thin netted or woven material or abiologic/synthetic membrane.

The primary bearing strut element inner edge and outer edge is taperedfrom the outer edge to the inner edge. The bearing surface includes aprimary bearing flare and a secondary flare extending below the primarybearing strut element. The secondary flare can be in the form of eithera vertical double tapered wing strut or obliquely extending arm.

The primary bearing strut element has at least one active or passivedampening element attached thereto and is fabricated of a biocompatiblematerial of the same type as set forth in the prior embodiments.

In yet another aspect of the present invention, a joint support andsubchondral support system for providing structural and dampeningsupport to damaged subchondral bone adjacent to a body joint includes aprimary bearing strut element of variable geometry and thickness havinga longitudinal body and an inner edge and an outer edge. Thelongitudinal body has porosity to allow vascularity, bridging bone, andother biological elements to pass through. The outer edge has at leasttwo grooves formed therein an inner surface of the longitudinal body andcontoured to fit the subchondral bone at the treatment site. Acontoured, porous plate having a variable shaped inner surface, outersurface, and peripheral surface of variable thickness extending betweenthe inner surface and the outer surface, suitable for insertion withinthe subchondral bone. The inner surface, outer surface, and peripheralsurface, each have a concave portion and a convex portion. The inneredge of the primary bearing strut element is in direct communicationwith the contoured porous plate within the subchondral bone beingtreated.

These and other features and advantages of this invention will becomefurther apparent from the detailed description and accompanying figuresthat follow. In the figures and description, numerals indicate thevarious features of the disclosure, like numerals referring to likefeatures throughout both the drawings and the description.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an embodiment of a joint support andsubchondral support system according to the present invention.

FIGS. 2A-2C illustrate the various degrees of porosity of the contoured,porous plate of the embodiment of FIG. 1.

FIGS. 3A-3B are perspective views of the dampening element of the jointsupport and subchondral support system according to the presentinvention.

FIGS. 4A-4E illustrate the placement of the device of FIG. 1 insubchondral bone of the tibial plateau.

FIG. 5A illustrates the placement of the device of FIG. 1 in subchondralbone of the femoral condyle and the tibial plateau as a monobloc insert.

FIG. 5B is a top plan view of the placement of the device of FIG. 1 insubchondral bone of the tibial plateau as both a modular insert and amonobloc insert.

FIG. 5C is a front perspective view of the placement of the device ofFIG. 1 in subchondral bone of the femoral trochlea.

FIG. 5D is a front perspective view of the placement of the device ofFIG. 1 in subchondral bone of the patella.

FIG. 6 is a perspective view of another embodiment of the joint supportand subchondral support system according to the present invention.

FIGS. 7A-7D illustrate the placement of the device of FIG. 6 insubchondral bone of a knee joint.

FIG. 8 illustrates the placement of the elongated plate separately fromthe plurality of strut elements within the subchondral bone of the kneejoint as a modular insert.

FIG. 9 is an enlarged perspective view of the elongated plate releasablyattached to the plurality of strut elements of FIG. 6.

FIGS. 10A-10C illustrate the various degrees of porosity of theplurality of strut elements of the embodiment of FIG. 6.

FIGS. 11A-11H illustrate a top view of several variable orientations orgeometries of the plurality of strut elements of the embodiment of FIG.6.

FIG. 12A illustrates an enlarged perspective view of the plurality ofsuperior struts of the embodiment of FIG. 6.

FIGS. 12B-12D illustrate various configurations of the flared bearingsurface of the embodiment of FIG. 6.

FIG. 12E is a perspective view of the secondary bearing element of theembodiment of FIG. 6.

FIG. 13A is a perspective view of the dampening element as a longcylinder housed in the periphery of the device of FIG. 6.

FIG. 13B is a perspective view of the dampening element as individualspheres embedded in the periphery of the device of FIG. 6.

FIG. 14A is a perspective view of a further embodiment of the jointsupport and subchondral support system according to the presentinvention.

FIG. 14B illustrates the various configurations of the primary bearingflare of the device of FIG. 14A.

FIG. 15 illustrates the placement of the device of FIG. 14A insubchondral bone of a knee joint in a parallel orientation.

FIGS. 16A-16C illustrate the various degrees of porosity of the deviceof FIG. 14A.

FIGS. 17A-17G illustrate an enlarged perspective view of each of thedifferent cross-sectional shapes of the device of FIG. 14A.

FIG. 18 illustrates the placement of the device of FIG. 14A insubchondral bone of a knee joint in a radial versus parallelorientation.

FIG. 19 is an enlarged perspective view of the porous, bearing surfaceof the embodiment of FIG. 14A with associated secondary flares.

FIG. 20A is a cut-away view of another embodiment of the joint supportand subchondral support system according to the present invention.

FIG. 20B is a perspective view of the embodiment of FIG. 20A illustratedas a complete circle.

FIGS. 21A-21C illustrate the various degrees of porosity of the deviceof FIG. 20.

FIGS. 22A-22B illustrate the outer edge of the device of FIG. 20 havingconcave and convex curvatures.

FIG. 22C illustrates the concentric taper of the primary bearing strutelement of the embodiment of FIG. 20.

FIG. 23 illustrates the placement of the device of FIG. 20 insubchondral bone of a knee joint by monobloc via antegrade insertion.

FIGS. 24A-24C illustrate the varying levels of the depth of penetrationof the device of FIG. 20.

FIG. 25A is an enlarged perspective view of an insertion holder used inconjunction with the embodiment of FIG. 20 during insertion of thedevice within the subchondral bone.

FIG. 25B illustrates the placement of the insertion holder spikes withineach of the grooves of the embodiment of FIG. 20 during insertion of thedevice within the subchondral bone.

FIG. 26 illustrates a perspective view of the bearing surface cover inaccordance with the embodiment of FIG. 20.

FIGS. 27A-27F illustrate the various geometric shapes that can be formedby the primary bearing strut elements of the embodiment of FIG. 20.

FIG. 28 illustrates the placement of the device of FIG. 18 insubchondral bone of a knee joint with multiple devices joined to eachother to form various patterns.

FIG. 29A is a cut-away view of the embodiment of FIG. 20 with a primarybearing flare.

FIG. 29B is a perspective view of the embodiment of FIG. 20 with asecondary flare.

FIG. 30 is a perspective view of a further embodiment of the jointsupport and subchondral system according to the present invention.

FIG. 31 illustrates the placement of the device of FIG. 30 insubchondral bone of a knee joint.

FIG. 32 is a perspective view of the placement of the joint support andsubchondral support system of each of the embodiments in subchondralbone of a knee joint.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The joint support and subchondral support system or device 10 of thepresent invention is generally illustrated in FIG. 1. It is contemplatedby the present invention that the joint support and subchondral supportsystem is not a substitute for partial or total joint replacement, butmay delay the need for joint replacement in active individuals withmoderate osteoarthritis and/or arthroses. By sustaining subchondral bonehomeostases, further joint deformity and disease progression may bedelayed and/or avoided. The joint support and subchondral support systemin accordance with the present invention enhances and reinforces thecartilage-bone complex in the presence of diseased cartilage or acartilage defect. It treats the bony side of the equation by mechanicalabsorption of shear and compressive stresses that threatencartilage-bone homeostasis.

A number of advantages of the joint support and subchondral supportsystem in accordance with the present invention are evident as follows:(1) the basic structure and mechanics of the system are applicable tomany parts of the joint, as any area with cartilage disease has anadjoining subchondral component; (2) minimal modifications inmanufacturing are necessary to apply this system to multiple areas,namely, the contour of the porous, plate closest to the joint; (3) thedevice may be inserted with minimal soft tissue dissection and minimalto no violation of the joint capsule if done in retrograde or side-slotinsertion methods; (4) antegrade devices also may be inserted with aminimal arthrotomy; for diffuse lesions with long anterior-posteriordimensions, two devices may be placed anterior and posterior to eachother through the same small arthrotomy; (5) the system is inherentlystable, as it occupies little space within the bone and is a jointscaffolding, not a replacement; and (6) the materials that comprise thesystem are dampening, thereby enhancing the trabecular bone's ability towithstand shock and shear stress.

The joint support and subchondral support system 10 includes acontoured, porous plate 12 having a variable shaped inner surface 14,outer surface 16, and peripheral surface 18 of variable thicknessextending between the inner surface 14 and the outer surface 16,suitable for insertion within the subchondral bone 20. The contoured,porous plate 12 inner surface 14, outer surface 16, and peripheralsurface 18 may be kidney-shaped, oval-shaped, or otherwise so shaped tofit within the subchondral bone 20 at the desired anatomic site. Theinner surface 14, outer surface 16, and peripheral surface 18 each havea respective concave portion 14A, 16A, 18A, and a respective convexportion 14B, 16B, 18B. The inner surface 14 of the contoured, porousplate 12 is closest to the joint 22 and the first part of the system 10that encounters stress. The inner surface 14 is configured to fit flushwith the respective geometries of the tibial and femoral sides of thejoint 22, and may be convex, concave, or complex to mirror theparticular anatomic location. The outer surface 16 will mirror thegeometry of the inner surface 14. The geometry of the inner surface 14,outer surface 16, and peripheral surface 18, may vary depending on theexact anatomic location being treated (i.e., proximal tibia versusfemoral trochlea) and the specific geometry of the lesion being treated.

The contours 32 of the porous plate 12 may be configured to match thechondral/subchondral curvature and anatomy of the specific joint 22location. Alternatively, the contours 32 may not be configured to matchthe chondral/subchondral 20 curvature and anatomy of the specific joint22 location such that the contours 32 are neutral or assume a reverse orvaried polarity.

The contoured, porous plate 12 has a porosity 24 to allow vascularityand other biologic elements from the host to pass through the contoured,porous plate 12. The porosity 24 of the contoured, porous plate 12 iswithin a range of from about 50 microns to about 20 mm. As shown inFIGS. 2A-2C, the porosity 24 of the contoured, porous plate 12 may becomprised of micropores 26, scaffold-like pores 28, or fibrous matrixmaterial 30.

Referring further to FIG. 1, the contoured, porous plate 12 includes aplurality of surface dimpling 34, which increases the surface area forstress absorption and converts as much shear stress to compressive ortensile stress, as the cartilage baseplate of the joint 22 has similarfeatures. The surface dimpling 34 has a radius of from about 50 micronsto about 3 mm. The contoured, porous plate 12 may further include aplurality of undersurface pimples 36, which increase the surface areabelow the contoured, porous plate 12 to spread the load. Theundersurface pimples 36 have a radius of from about 50 microns to about3 mm.

The dimensions of the system or device 10 generally depend on the sizeof the lesion being treated. Typically, two or more devices 10 will bedeployed per location for diffuse disease and one device for smallerlesions. The vertical dimension ranges from about 1 mm to about 100 mmand the horizontal dimension ranges from about 1 mm to about 100 mm. Thecontoured, porous plate 12 has a cross-sectional area of from about 1mm² to about 100 cm². The peripheral surface 18 of the contoured, porousplate 12 has a variable thickness of from about 0.1 mm to about 5 cm. Atleast one active or passive dampening element 38 is attached to thecontoured, porous plate 12. A dampening element, such as a piezoelectricdevice, converts active mechanical energy to heat or electric, therebydissipating and dampening the shock. A passive dampening element 38 maybe made of silicone or other shock-absorbing material. Either active orpassive dampening element 38 may be incorporated into plate asillustrated in FIGS. 3A-3B. FIG. 3A illustrates the dampening element 38as a long cylinder housed in the periphery of the device 10. FIG. 3Billustrates the dampening element 38 as individual spheres embedded inthe periphery of device 10. The dampening element 38 may also beinherent within the material properties of the device, and not aseparate component, i.e., silicone-impregnated porous metal matrix.

Referring to FIG. 4, at least one to multiple guide pin holes or slots40 are located within device 10 to aid insertion within the subchondralbone 20. The guide pin(s) 42 are inserted into the anatomic siteinitially (FIG. 4A) with device 10 inserted over the guide pin(s) 42(FIG. 4B). A bone cutter/dilator 44 is inserted over the guide pin(s) 42to create an entry opening and slot 45 for device 10 (FIG. 4C). The bonecutter or dilator 44 is smaller in dimension than device 10, therebyallowing a press-fit fixation. The device 10 is inserted over the guidepin(s) 42 via the holes or slots 40 (FIG. 4D). The excess guide pin(s)42 may break away or be removed after device 10 is inserted within thesubchondral bone 20. One guide pin 42 may be used initially as device 10is allowed small amounts of swiveling to more exactly fit the contoursof the subchondral baseplate 20. Placement of the guide pin 42 into thesubchondral defect 20 may be accomplished by either fluoroscopicguidance, CT guidance, computer navigation guidance, or direct guidance.In one embodiment, the guide pin 42 may be configured to break away fromthe contoured, porous plate 12 upon insertion of the device 10 withinthe subchondral bone 20.

The operation of the device 10 for the femur involves placing a guidepin 42 into the center of the subchondral defect 20 from within thejoint 22. This is followed by a bone cutter or dilator 44 to prepare thebone. The device 10 is then inserted over the guide pin 42 andpositioned flush with the subchondral bone 20 with a tamp. The insertionof the device 10 is peripheral or tangential to the joint surface (FIG.4E).

FIG. 5A illustrates the placement of the joint support and subchondralsupport system or device 10 in subchondral bone 20 of the femoralcondyle and the tibial plateau as a monobloc 48 insert. FIG. 5B is a topplan view of the placement of the device 10 in subchondral bone 20 ofthe tibial plateau as both a modular 46 and a monobloc 48 insert. Asshown in FIG. 5B, the contoured, porous plate 12 may be inserted in atleast two different locations of the subchondral bone 20 as a modular 46or monobloc 48 insert. FIG. 5C is a front perspective view of theplacement of the device 10 in subchondral bone 20 of the femoraltrochlea. FIG. 5D is a front perspective view of the placement of thedevice 10 in subchondral bone 20 of the patella.

The joint support and subchondral support system 10 of the presentinvention may be fabricated from virtually any biocompatible material,including, but not limited to, metals, metal alloys, carbon fibers, foammetals, ceramics, ceramic composites, elastomer composites,elastomer-carbon fiber composites, chambered or fluid-filled materials,metal matrices, injectable gels, injectable composites with fluid andsold matrices, bone or bone-composite or allografts, crystal orhydroxyapatite materials, plastics (i.e., PEEK), polymers, bioabsorbablecomposites (i.e., TCP/PLLA), or composites/combinations of the abovematerials. The preferred materials for the system 10 have inherentelastic or shock absorbing properties.

In another embodiment as shown in FIG. 6, the joint support andsubchondral support system or device 50 includes an elongated plate 52having a plurality of tapered strut elements 54 of variable geometry andthickness oriented in a vertical configuration for insertion into thesubchondral bone 20. The strut elements 54 include a plurality ofsuperior struts 56 formed on an upper portion 58 of the plate 52 and aplurality of inferior struts 60 formed on a lower portion 62 of theplate 52. The plurality of inferior struts 60 may be configured to beout of plane with the plurality of superior struts 56. There may besingle to multiple superior or inferior struts depending on the size ofpathologic lesion being treated.

FIG. 7A illustrates the placement of the joint support and subchondralsupport system 50 in subchondral bone 20 of the femoral condyle andtibial plateau and patella in accordance with the present invention.

It is contemplated by the present invention that the elongated plate 52may be inserted separately from the plurality of strut elements 54within the subchondral bone 20 as a modular insert 64 shown in FIG. 8.

The elongated plate 52 serves as a secondary bearing element anddissipates stresses centripetally and absorbs stress inherently. Theelongated plate 52 thickness and material properties may vary to enablestress transmission outward. The elongated plate 52 prevents subsidenceof the structural support system 50. The dimension of the elongatedplate 52 is dependant on the size of lesion being treated. The verticaldimension ranges from about 1 mm to about 100 mm and the horizontaldimension ranges from about 1 mm to about 100 mm. The elongated plate 52has a cross-sectional area of from about 1 mm² to about 100 cm².

In one embodiment of FIG. 9, the elongated plate 52 is shown releasablyattached to the plurality of strut elements 54 with smoothly roundedjoint elements 66 at each intersection of the strut elements 54 and theelongated plate 52. The plurality of superior 56 and inferior 60 strutshave a width of from about 0.1 mm to about 10 mm and a height of fromabout 0.5 mm to about 35 mm.

The plurality of superior struts 56 serves to accept the load from theadjoining joint 22. The level of penetration of the superior struts 56within the subchondral bone 20 includes as follows: the superior struts56 may stop short or come up to the cartilage base plate, may penetratethe cartilage base plate and reside in the lower cartilage layer, or maycome flush to the native bearing cartilage surface. The plurality ofinferior struts 60 reinforces the structural integrity of the elongatedplate 52 and enables centripetal transmission/dissipation of forces tounderlying and surrounding structures (i.e., bone or soft tissue).

As shown in FIGS. 10A-10C, the plurality of strut elements 54 may befabricated to have a porosity comprised of micropores 68, scaffold-likepores 70, or fibrous matrix material 72. The porosity of the pluralityof strut elements is within a range of from about 50 microns to about 20mm.

The plurality of strut elements 54 may have a variable orientation orgeometry such as sinusoidal 74 (FIG. 11A), parallel 76 (FIG. 11B),radial 78 (FIG. 11C), circular 80 (FIG. 11D), curved (FIG. 11E),geometric-rectangular 82, trapezoidal 84, hexagonal 86, octagonal 88(FIG. 11F), cross-hatching or cross-elements 90 (FIG. 11G), or singlecolumns 91 (FIG. 11H).

FIG. 12A illustrates an enlarged perspective view of the plurality ofsuperior struts 56 of the joint support and subchondral support system50 of FIG. 6. The plurality of superior struts 56 have a primary bearingelement 92 configured to be contoured such that the primary bearingelement 92 is generally the same as the corresponding subchondral bone20 being treated. The primary bearing element 92 has an ultra-lowcoefficient of friction surface that is polished or fabricated of abiocompatible material. The primary bearing element 92 includes a flaredbearing surface 94 that is substantially wider than each of theplurality of superior struts 56. The flared bearing surface 94 may beconfigured to assume a variety of shapes such as circular (FIG. 12B),flat (FIG. 12C), mushroom-like (FIG. 12D), and the like. The flaredbearing surface 94 has a width of from about 1.1 to about 4× a width ofeach of the plurality of superior struts 56. The plurality of superiorstruts 56 may include at least one secondary bearing element 96 (FIG.12E) that connects the plurality of superior struts 56 to each other.The secondary bearing element 96 has a width of from about 0.5 to about5× the width of the superior strut 56.

A guide pin hole or slot 98 is positioned within the elongated plate 52oriented longitudinally for insertion and placement of the plate 52 andplurality of strut elements 54 over at least one corresponding guide pin102 within the subchondral bone 20 (FIGS. 7B-7D). At least one tomultiple guide pin holes or slots 98 are located within device 50 to aidinsertion within the subchondral bone 20. The guide pin(s) 102 isinserted into the anatomic site initially (FIG. 7C). A bonecutter/dilator 100 is inserted over the guide pin(s) 102 to create anentry opening and slot 98 for device 50 (FIG. 7D). The bonecutter/dilator 100 is smaller in dimension than device 50, therebyallowing a press-fit fixation. The device 50 is inserted over the guidepin(s) 102 via the guide pin holes or slots 98 (FIG. 7D). The excessguide pin(s) 102 may break away or be removed after device 50 isinserted within the subchondral bone 20. Placement of the guide pin 102into the subchondral defect 20 may be accomplished by eitherfluoroscopic guidance, CT guidance, computer navigation guidance, ordirect guidance. In one embodiment, the guide pin 102 may be configuredto break away from the elongated plate 52 upon insertion of the device50 within the subchondral bone 20.

Referring further to FIG. 7, the operation of the device 50 for thefemur involves placing a guide pin 102 into the center of thesubchondral defect 20 from within the joint 22. This is followed by abone cutter/dilator 100 to prepare the bone. The device 50 is theninserted over the guide pin 102 and positioned flush with thesubchondral bone 20 with a tamp. The insertion of the device 50 isperipheral or tangential to the joint surface (FIG. 7).

At least one active or passive dampening element 104 is attached to theelongated plate 52 and plurality of strut elements 54 (FIG. 13). Anactive dampening element, such as a piezoelectric device, convertsactive mechanical energy to heat or electric, thereby dissipating anddampening the shock. FIG. 13A illustrates the dampening element 104 as along cylinder housed in the periphery of the device 50. FIG. 13Billustrates the dampening element 104 as individual spheres embedded inthe periphery of the device 50. A passive dampening element may be madeof silicone or other shock-absorbing material. Either active or passivedampening element 104 may be incorporated into plate 52 as illustratedin FIGS. 13A-13B. The dampening element may also be inherent within thematerial properties of the device 50, and not a separate component,i.e., silicone-impregnated porous metal matrix.

The joint support and subchondral support system 50 of the presentinvention may be fabricated from virtually any biocompatible material,including, but not limited to, metals, metal alloys, carbon fibers, foammetals, ceramics, ceramic composites, elastomer composites,elastomer-carbon fiber composites, chambered or fluid-filled materials,metal matrices, injectable gels, injectable composites with fluid andsold matrices, bone or bone-composite or allografts, crystal orhydroxyapatite materials, plastics (i.e., PEEK), polymers, bioabsorbablecomposites (i.e., TCP/PLLA), or combinations/composites of the abovematerials. The preferred materials for the system 50 have inherentelastic or shock absorbing properties.

In a further embodiment as shown in FIG. 14A, the joint support andsubchondral support system 106 includes a plurality of separate verticalstruts 108 of variable geometry and thickness having a first end 110 anda second end 112, suitable for modular insertion 114 within thesubchondral bone 20. At least one of the plurality of vertical strutsfirst end 110 and second end 112 is tapered to assist in progressivelydissipating stress. The plurality of vertical struts 108 further includea porous, bearing surface 116 contoured to fit the subchondral bone 20being treated. The porous, bearing surface 116 is configured to includea primary bearing flare 118 of various configurations (FIG. 14B). Theprimary bearing flare 118 prevents subsidence of the joint support andsubchondral support system 106.

FIG. 15 illustrates the joint support and subchondral support system 106in subchondral bone 20 of the femoral condyle and tibial plateau inaccordance with the present invention.

As shown in FIGS. 16A-16C, the device 106 may have a porosity comprisedof micropores 118, scaffold-like pores 120, or fibrous matrix material122. The porosity of the device 106 is within a range of from about 50microns to about 20 mm.

FIGS. 17A-17G illustrate an enlarged perspective view of the differentcross-sectional shapes of the strut device 108, such as a triangular(both polarities) (FIG. 17A), smooth thermometer-like (FIG. 17B),trapezoid (FIG. 17C), flared diamond-shaped (FIG. 17D), oval (FIG. 17E),complex (tapered with flared-diamond) (FIG. 17F), and rectangular (FIG.17G).

The plurality of vertical struts 108 can be inserted in either aparallel orientation 140 (FIGS. 15 and 18) or a radial orientation 142(FIG. 18) within the subchondral bone 20. Radial orientation may enablecentripetal load dissipation within the subchondral bone. The top-downgeometry of the struts may be curved 108A, straight 108B, or sinusoidal108C as shown in FIG. 18.

The embodiment of FIG. 19 illustrates an enlarged perspective view ofthe porous, bearing surface 116 having a secondary bearing flare 144extending below the bearing surface 116. The secondary bearing flare 144distributes the load horizontally, along the vertical length of theplurality of vertical struts 108. The secondary bearing flare 144 can bein the form of either a horizontal wing strut 146 or dimple 148. Thedimple 148 can be asymmetric in shape in which it is wider towards thejoint.

It is contemplated by the present invention that the plurality ofvertical struts 108 are implanted within the subchondral bone 20 viaside slot insertion as shown in FIG. 15.

Referring further to FIG. 19, at least one active or passive dampeningelement 150 is attached to the plurality of vertical struts 108. Thedampening element may be within the main strut body 150A or housedwithin the secondary bearing flare 150B. A dampening element, such as apiezoelectric device, converts active mechanical energy to heat orelectric, thereby dissipating and dampening the shock. The dampeningelement 150 may also be inherent in the material properties of thedevice 106, i.e., silicone-injected porous metal matrix.

The joint support and subchondral support system 106 of the presentinvention may be fabricated from virtually any biocompatible material,including, but not limited to, metals, metal alloys, carbon fibers, foammetals, ceramics, ceramic composites, elastomer composites,elastomer-carbon fiber composites, chambered or fluid-filled materials,metal matrices, injectable gels, injectable composites with fluid andsold matrices, bone or bone-composite or allografts, crystal orhydroxyapatite materials, plastics (i.e., PEEK), polymers, bioabsorbablecomposites (i.e., TCP/PLLA), or combinations/composites of the abovematerials. The preferred materials for the system 106 have inherentelastic or shock absorbing properties.

In still a further embodiment of FIG. 20, the joint support andsubchondral support system 150 includes a primary bearing strut element152 of variable geometry and thickness having a longitudinal body 154and an inner edge 156 and an outer edge 158, suitable for insertionwithin the subchondral bone 20. The basic geometric shape 162 of theprimary bearing strut element 152 is a circle as illustrated as acut-away in FIG. 20A and as a complete circle in FIG. 20B. At least oneof the plurality of strut elements inner edge 156 and outer edge 158 istapered. The longitudinal body 154 has a porosity 155 to allowvascularity, bridging bone, and other biologic elements to pass through.The porosity 155 of the primary bearing strut element 152 ranges from 50microns to 20 mm. As shown in FIGS. 21A-21C, the porosity 155 may becomprised of micropores, scaffold-like pores, or a fibrous matrixmaterial, respectively.

The outer edge 158 of the primary bearing strut element 152 is contouredto fit the subchondral bone 20 at the treatment site. As shown in FIGS.22A-22B, the outer edge 158 may be concave (FIG. 22A) such as the tibialplateau, convex (FIG. 22B) such as the femoral condyle, or complex (notshown) with both concave and convex curvatures, such as the femoraltrochlea. The inner edge 156 includes scalloping for penetration of thesubchondral bone 20 during insertion of the system 150. The outer edge158 has at least two grooves 151 (FIG. 20) formed therein an innersurface 153 of the longitudinal body 154. In addition to the thicknesstaper that exists between the outer edge 158 and inner edge 156, aconcentric taper 147 of the entire circle is present from the outer edge158 to the inner edge 156 (FIG. 22C). This allows for subjacentplacement in a convex surface 149 as well as further preventingsubsidence. The degree of this taper 147 may range from 3-10 degrees.

FIG. 23 illustrates the placement of the joint support and subchondralsupport system 150 in the subchondral bone 20 of the femoral condyle andtibial plateau in accordance with the present invention. The depth ofpenetration of the device 150 may vary depending on the exact pathologybeing treated as seen in FIGS. 24A-24C such that it may be below thelevel of the subchondral plateau (FIG. 24A), at the level of thesubchondral plateau (FIG. 24B), or above the subchondral plateau, flushwith the native cartilage (FIG. 24C).

FIG. 25A is an enlarged perspective view of an insertion holder 155 usedin conjunction with the embodiment of FIG. 20 during insertion of thejoint support and subchondral support system or device 150 within thesubchondral bone 20. The insertion holder 155 has a proximal 157 anddistal end 159. A plurality of spikes 161 at the distal end 159 areconfigured to fit in at least two grooves or vascular channels 151 atthe outer edge 158 on the inner surface 153 of the longitudinal body 154to effectively hold the device 150 during its insertion within thesubchondral bone. It is contemplated by the present invention that oneinsertion holder 155 may be used per device 150.

FIG. 25B illustrates the placement of the insertion holder spikes 161within each of the grooves or vascular channels 151 of the embodiment ofFIG. 20 during insertion of the device 150 within the subchondral bone20. During insertion of the device 150, the plurality of spikes 161 atthe insertion holder distal end 159 are pushed downward in the groovesor vascular channels 151 and are preferably extended past the inner edge156. The plurality of spikes 161 from the inserter holder 155 exit atthe scalloped inner edge 156 and are pushed deeper into the subchondralbone 20. The device 150 and insertion holder 155 is then tamped into thesubchondral bone 20 and the insertion holder 155 is then removed (notshown). The plurality of spikes 161 extended beyond the inner edge 156create channels in the subchondral bone 20 whereby blood/marrow mayaccess the outer edge 158 of the primary bearing strut element 152 viathe grooves or vascular channels 151. Grooves 151 may also be in theform of holes within the primary bearing strut element 152.

As shown in FIG. 26, it is further contemplated by the present inventionthat a bearing surface cover 163 may be attached to the periphery of theouter edge 158 that serves to contain marrow contents entering via thevascular channels or exogenous substances, injected through the cover(i.e., cultured chondrocytes). This cover 163 is made of either a thinnetted or woven material or biologic/synthetic membrane.

As shown in FIGS. 27A-27F, the geometric shape 162 of the primarybearing strut elements 152 can be a circle (FIG. 27A), multipleconcentric circle (FIG. 27B), joined circles (FIG. 27C), hexagon (FIG.27D), or octagon (FIG. 27E) or other non-linear, non-euclidean shapes,such as a hexagon with smoothed edges (FIG. 27F). The primary bearingstrut elements 152 configured to be joined together include at leastthree connecting struts 164 to form a multiple concentric circle (FIG.27B) in which each circle 166 of joined together primary bearing strutelements 152 is connected to an adjacent circle 166 by the connectingstruts 164.

It is further contemplated by the present invention that single ormultiple geometric shapes 162 may be configured to be joined to eachother in various patterns 168 (i.e., a honey-comb configuration) (FIG.28) such that the geometric shapes 162 may penetrate the subchondralbone 20 and enable use with different size cartilage lesions at thetreatment site. The geometric shapes 162 may mirror the entire jointcompartment if the entire compartment is involved, i.e., trochlea,lateral patellar facet, medial tibial platea, etc. The geometric shapes162 may be inserted within the subchondral bone 20 either piecemeal ormonobloc via antegrade insertion (i.e., from the joint surface).

The dimensions of the joint support and subchondral support system 150generally depend on the size of the lesion being treated. In particular,the primary bearing strut elements 152 configured to be joined togetherin a geometric shape 162 each have a diameter of from about 1 mm toabout 5 cm and a height/depth of from about 1 mm to about 3 cm.

FIG. 29A illustrates a cut-away view of the primary bearing strutelement 152 with a primary bearing flare 170. In a further embodimentshown in FIG. 29B, the primary bearing strut element 152 includes asecondary bearing flare 172 extending below the strut element 152. Thesecondary bearing flare 172 can be in the form of either a verticaldouble tapered wing strut 174 or obliquely extending arm 176. Thesesecondary flares 172 serve to further resist subsidence.

At least one active or passive dampening element 178 (FIG. 29B) isattached to the primary bearing strut element 152. The dampening elementmay be inherent to the material properties of the device 150, i.e.,silicone-inject porous metal matrix. A dampening element, such as apiezoelectric device, converts active mechanical energy to heat orelectric, thereby dissipating and dampening the shock.

The joint support and subchondral support system 150 of the presentinvention may be fabricated from virtually any biocompatible material,including, but not limited to, metals, metal alloys, carbon fibers, foammetals, ceramics, ceramic composites, elastomer composites,elastomer-carbon fiber composites, chambered or fluid-filled materials,metal matrices, injectable gels, injectable composites with fluid andsold matrices, bone or bone-composite or allografts, crystal orhydroxyapatite materials, plastics (i.e., PEEK), polymers, bioabsorbablecomposites (i.e., TCP/PLLA), or combinations/composites of the abovematerials. The preferred materials for the system 150 have inherentelastic or shock absorbing properties.

Referring now to FIG. 30 in a further embodiment of the presentinvention, the joint support and subchondral support system 180 includesa primary bearing strut element 182 of variable geometry and thicknesshaving a longitudinal body 184 and an inner edge 186 and an outer edge188. The longitudinal body 184 has a porosity to allow vascularity,bridging bone, and other biological elements to pass through. The outeredge 188 has at least two grooves 189 formed therein an inner surface190 of the longitudinal body 184 and contoured to fit the subchondralbone 20 at the treatment site. The system 180 further includes acontoured, porous plate 192 having a variable shaped inner surface 194,outer surface 196, and peripheral surface 198 of variable thicknessextending between the inner surface 194 and outer surface 196, suitablefor insertion within the subchondral bone 20. The inner surface 194,outer surface 196, and peripheral surface 198 each have a respectiveconcave portion 194A, 196A, 198A and a respective convex portion 194B,196B, 198B. The inner edge 186 of the primary bearing strut element 182is in direct communication with the contoured, porous plate 192 withinthe subchondral bone being treated. The contoured, porous plate 192 ofthe joint support and subchondral support system 180 may include aplurality of surface dimples 202 and undersurface pimples 204 aspreviously described above.

FIG. 31 illustrates the placement of the joint support and subchondralsupport system 180 in the subchondral bone 20 of the femoral condyle andtibial plateau in accordance with the present invention.

It is contemplated by the present invention that the joint support andsubchondral support system 180 may be inserted within the subchondralbone 20 according to the insertion techniques previously discussedabove.

At least one active or passive dampening element 206 is attached to thejoint support and subchondral support system 180. A dampening element,such as a piezoelectric device, converts active mechanical energy toheat or electric, thereby dissipating and dampening the shock.

As with the previous embodiments, the joint support and subchondralsupport system 180 of the present invention may be fabricated fromvirtually any biocompatible material, including, but not limited to,metals, metal alloys, carbon fibers, foam metals, ceramics, ceramiccomposites, elastomer composites, elastomer-carbon fiber composites,chambered or fluid-filled materials, metal matrices, injectable gels,injectable composites with fluid and sold matrices, bone orbone-composite or allografts, crystal or hydroxyapatite materials,plastics (i.e., PEEK), polymers, bioabsorbable composites (i.e.,TCP/PLLA), or combinations/composites of the above materials. Thepreferred materials for the system 180 have inherent elastic or shockabsorbing properties.

FIG. 32 illustrates the placement of the joint support and subchondralsupport system 10, 50, 106, 150, 180 of each of the aforementionedembodiments discussed above in subchondral bone 20 of a knee joint 22.The present invention contemplates that each of the embodiments of thejoint support and subchondral support system 10, 50, 106, 150, 180 maybe used in combination with one another to provide enhanced structuraland dampening support to damaged subchondral bone 20 adjacent to a bodyjoint.

The above-described elements for each of the embodiments may be variedin design, function, operation, configuration, materials, anddimensions, and are not limited to the descriptions provided herein.

Having now described the invention in accordance with the requirementsof the patent statutes, those skilled in the art will understand how tomake changes and modifications in the present invention to meet theirspecific requirements or conditions. Such changes and modifications maybe made without departing from the scope and spirit of the invention asset forth in the following claims.

1. A joint support and subchondral support system for providingstructural and dampening support to damaged subchondral bone adjacent toa body joint, comprising: a contoured, porous plate having a variableshaped inner surface, outer surface, and peripheral surface of variablethickness extending between the inner surface and the outer surface,suitable for insertion within the subchondral bone; the inner surface,outer surface and peripheral surface each having a concave portion and aconvex portion; wherein at least one guide pin hole or slot is locatedwithin the contoured, porous plate to aid insertion and placement of theplate over at least one corresponding guide pin within the subchondralbone.
 2. The joint support and subchondral support system of claim 1,wherein the porosity of the contoured plate is within a range of fromabout 50 microns to about 20 mm.
 3. The joint support and subchondralsupport system of claim 2, wherein the contoured, porous plate includesat least one of micropores, scaffold-like pores, and fibrous matrixmaterial.
 4. The joint support and subchondral support system of claim1, wherein the contoured, porous plate includes a plurality of surfacedimpling thereon having a radius of from about 50 microns to about 3 mm.5. The joint support and subchondral support system of claim 1, whereinthe contoured, porous plate includes a plurality of undersurface pimplesthereon having a radius of from about 50 microns to about 3 mm.
 6. Thejoint support and subchondral support system of claim 1, wherein thecontoured, porous plate may be configured to fit flush with at least onecontour of the corresponding subchondral bone at a specific body jointlocations.
 7. The joint support and subchondral support system of claim1, wherein the contoured, porous plate may be inserted in at least twolocations of the subchondral bone as a modular or monobloc insert. 8.The joint support and subchondral support system of claim 1, wherein theinner surface, outer surface and peripheral surface each have ageometry, which varies according to the exact anatomic location beingtreated and specific geometry of lesion being treated.
 9. The jointsupport and subchondral support system of claim 1, wherein at least oneguide pin may be configured to break away from the contoured, porousplate upon insertion of the plate within the subchondral bone.
 10. Thejoint support and subchondral support system of claim 1, wherein thecontoured, porous plate has a cross-sectional area or from about 1 mm²no about 100 cm².
 11. The joint support and subchondral support systemof claim 1, wherein the contoured, porous plate has a vertical dimensionof from about 1 mm to about 100 mm and a horizontal dimension of fromabout 1 mm about 100 mm.
 12. The joint support and subchondral supportsystem or claim 1, wherein the peripheral surface has a variablethickness of from about 0.1 mm to about 5 cm.
 13. The joint support andsubchondral support system of claim 1, wherein the insertion of thecontoured, porous plate is peripheral or tangential to a body jointsurfaces.
 14. The joint support and subchondral support system of claim1, wherein the contoured, porous plate has at least one active orpassive dampening element attached thereto.
 15. The joint support andsubchondral support system of claim 1, wherein the contoured, porousplate is fabricated of a biocompatible material selected from the groupconsisting of metals, metal alloys, carbon fibers, foam metals,ceramics, ceramic composites, elastomer composites, elastomer-carbonfiber composites, chambered or fluid-filled materials, metal matrices,injectable gels, injectable composites with fluid and sold matrices,bone or bone-composite or allografts, crystal or hydroxyapatitematerials, plastics, polymers, bioabsorbable composites, orcomposites/combinations of the above materials.
 16. A joint support andsubchondral support system for providing structural and dampeningsupport to damaged subchondral bone adjacent to a body joint,comprising: an elongated plate having a plurality of tapered strutelements of variable geometry and thickness oriented in a verticalconfiguration for insertion into the subchondral bone; the strutelements comprising a plurality of superior struts formed on an upperportion of the plate and a plurality of inferior struts formed on alower portion of the plate, wherein the plurality of inferior struts maybee configured to be out of plane with the plurality of superior struts.17. The joint support and subchondral support system of claim 16,wherein the elongated plate may be inserted separately from theplurality of strut elements within the subchondral bone as a modularinsert.
 18. The joint support and subchondral support system of claim16, wherein the plurality of strut elements has a porosity of at leastone of micropores, scaffold-like pores, and fibrous matrix material. 19.The joint support and subchondral support system of claim 16, whereinthe elongated plate may be releasably attached to the plurality of strutelements with smoothly rounded joint elements at each intersection ofthe strut elements and the elongated plate.
 20. The joint support andsubchondral support system of claim 16, wherein the plurality of strutelements may have a variable orientation or geometry of at least one ofsinusoidal, parallel, radial, circular, curved, rectangular,trapezoidal, hexagonal, octagonal, cross-hatching, and cross-elements.21. The joint support and subchondral support system of claim 16,wherein the plurality of the superior and inferior struts have a widthof from about 0.1 mm to about 10 mm and a height of from about 0.5 mm toabout 35 mm.
 22. The Joint support and subchondral support system ofclaim 16, wherein the plurality of superior struts has a primary bearingelement configured to be contoured such that the primary bearing elementis generally the same as the corresponding subchondral none beingtreated.
 23. The joint support and subchondral support system of claim22, wherein the primary bearing element includes a flared bearingsurface that is substantially wider than each of the plurality ofsuperior struts.
 24. The joint support and subchondral support system ofclaim 23, wherein the flared bearing surface has a width of from about1.1 to about 4× a width of each of the plurality of superior struts. 25.The joint support and subchondral support system of claim 16, whereinthe plurality of superior struts may include at least one secondarybearing element that connects the plurality of superior struts to eachother.
 26. The joint support and subchondral support system of claim 25,wherein the at least one secondary bearing element has a width of fromabout 0.5 to about 5× a width of the superior strut.
 27. The jointsupport and subchondral support system of claim 16, wherein at least oneguide hole or slot is located within the elongated plate to aidinsertion and placement of the plate and plurality of strut elementsover at least one corresponding guide pin within the subchondral bone.28. The joint support and subchondral support system of claim 16,wherein the elongated plate and plurality of strut elements have atleast one active or passive dampening element attached thereto.
 29. Thejoint support and subchondral support system of claim 16, wherein theelongated plate and plurality of strut elements are fabricated of abiocompatible material selected from the group consisting of metals,metal alloys, carbon fibers, foam metals, ceramics, ceramic composites,elastomer composites elastomer-carbon fiber composites, chambered orfluid-filled materials, metal matrices, injectable gels, injectablecomposites with fluid and sold matrices, bone or bone-composite orallografts, crystal or hydroxyapatite materials, plastics, polymers,bioabsorbable composites, or composites/combinations of the abovematerials.
 30. A joint support and subchondral support system forproviding structural and dampening support to damaged subchondral boneadjacent to a body joint, comprising: a plurality of vertical struts ofvariable geometry and thickness having a first end and a second end,suitable for modular insertion within the subchondral bone; theplurality of vertical struts further comprising a porous, bearingsurface that is contoured to fit the subchondral bone being treated,wherein the porous, bearing surface includes a primary bearing flare.31. The joint support and subchondral support system of claim 30,wherein the vertical struts may have a porosity comprised of micropores,scaffold-like pores, or fibrous matrix material.
 32. The joint supportand subchondral support system of claim 30, wherein the vertical strutsmay have a cross-sectional shape of at least one of a triangle,thermometer-shape, trapezoid, flared diamond-shape, oval, tapered withflared diamond-shape, and rectangle.
 33. The joint support andsubchondral support system of claim 30, wherein at least one of theplurality of vertical struts first end and second end is tapered toassist in progressively dissipating stress within the subchondral bone.34. The joint support and subchondral support system of claim 30,wherein the porous, bearing surface includes a secondary bearing flareextending below the bearing surface.
 35. The joint support andsubchondral support system of claim 34, wherein the secondary bearingflare is at least one of a horizontal wing strut and dimple.
 36. Thejoint support and subchondral support system of claim 30, wherein theplurality of vertical struts are inserted in at least one of a paralleland radial orientation within the subchondral bone.
 37. The jointsupport and subchondral support system of claim 30, wherein at least oneactive or passive dampening element is attached to the plurality ofvertical struts.
 38. A joint support and subchondral support system forproviding structural and dampening support to damaged subchondral boneadjacent to a body joint, comprising: a primary bearing strut element ofvariable geometry and thickness having a longitudinal body and an inneredge and an outer edge, suitable for insertion within the subchondralbone; the longitudinal body having a porosity to allow vascularity,bridging bone, and other biological elements to pass through; the inneredge having scalloping to penetrate the subchondral bone duringinsertion; and the outer edge having at least two grooves formed thereinan inner surface of the longitudinal body and contoured to fit thesubchondral bone at the treatment site.
 39. The joint support andsubchondral support system of claim 38, wherein an inserter holder maybe slidably disposed through the at least two grooves at the outer edgeon the inner surface of the longitudinal body and extended past theinner edge during insertion of the strut element within the subchondralbone.
 40. The joint support and subchondral support system of claim 39,wherein the inserter holder has a plurality of spikes at a distal endthat may be slidably disposed within the at least two grooves at theouter edge on the inner surface of the longitudinal body.
 41. The jointsupport and subchondral support system of claim 40, wherein theplurality of spikes extend past the inner edge create channels in thesubchondral bone whereby blood or marrow may access the outer edgethrough the grooves or vascular channels.
 42. The joint support andsubchondral support system of claim 38, wherein the geometric shape ofthe primary bearing strut element is a circle.
 43. The joint support andsubchondral support system of claim 38, wherein single or multiplegeometric shapes of the primary bearing strut elements may be configuredto be joined to each other in various patterns such that the geometricshapes may penetrate the subchondral bone to be treated.
 44. The jointsupport and subchondral support system of claim 43, wherein the singleor multiple geometric shapes configured to be joined together include atleast three connecting struts to form a multiple concentric circle inwhich each circle of the primary bearing strut element is connected toan adjacent circle by the connecting struts.
 45. The joint support andsubchondral support system of claim 38, wherein the primary bearingstrut element has a diameter of from about 1 mm to about 5 cm and aheight/depth of from about 1 mm to about 3 cm.
 46. The joint support andsubchondral support system of claim 38, wherein inner edge and outeredge of the primary bearing strut element is tapered.
 47. The jointsupport and subchondral support system of claim 38, wherein thelongitudinal body includes a primary bearing flare.
 48. The jointsupport and subchondral support system of claim 38, wherein thelongitudinal body includes a secondary flare extending below thelongitudinal body.
 49. The Joint support and subchondral support systemof claim 38, wherein the secondary flare is at least one of a vertical,double-tapered wing strut and obliquely extending arm.
 50. The jointsupport and subchondral support system of claim 38, wherein the porosityof the longitudinal body may be comprised of micropores, scaffold-likepores, or a fibrous matrix material.
 51. The joint support andsubchondral support system of claim 38, wherein the primary bearingstrut element includes a concentric taper from the outer edge to theinner edge.
 52. The joint support and subchondral support system ofclaim 38, wherein the primary bearing strut element may have a geometryin the form of a multiple concentric circle, joined circles, hexagon,octagon, or other non-euclidean shapes.
 53. The joint support andsubchondral support system of claim 38, wherein a bearing surface covermay be attached to a periphery of the outer edge to contain marrowcontents entering through vascular channels or exogenous substancesinjected through the cover.
 54. The joint support and subchondralsupport system of claim 53, wherein the bearing surface cover isfabricated from a thin, netted or woven material or biologic/syntheticmembrane.
 55. The joint support and subchondral support system of claim38, wherein at least one active or passive dampening element is attachedto the primary bearing strut element.
 56. The joint support andsubchondral support system or claim 38, wherein the primary bearingstrut element is fabricated of a biocompatible material selected fromthe group consisting of metals, metal alloys, carbon fibers, foammetals, ceramics, ceramic composites, elastomer composites,elastomer-carbon fiber composites, chambered or fluid-filled materials,metal matrices, injectable gels, injectable composites with fluid andsold matrices, bone or bone-composite or allografts, crystal orhydroxyapatite materials, plastics, polymers, bioabsorbable composites,or composites/combinations of the above materials.
 57. A joint supportand subchondral support system for providing structural and dampeningsupport to damaged subchondral bone adjacent to a body joint,comprising: a primary bearing strut element of variable geometry andthickness having a longitudinal body and an inner edge and an outeredge; the longitudinal body having a porosity to allow vascularity,bridging bone, and other biological elements to pass through; the outeredge having at least two grooves formed therein an inner surface of thelongitudinal body and contoured to fit the subchondral bone at thetreatment site; a contoured, porous plate having a variable shaped innersurface, outer surface, and peripheral surface of variable thicknessextending between the Inner surface and the outer surface, suitable forinsertion within the subchondral bone; the inner surface, outer surfaceand peripheral surface each having a concave portion and a convexportion; wherein the inner edge of the primary bearing strut element isin direct communication with the contoured porous plate within thesubchondral bone being treated.
 58. The joint support and subchondralsupport system of claim 57, wherein the primary bearing strut elementhas at least one active or passive dampening element attached thereto.59. The joint support and subchondral support system of claim 57,wherein the contoured, porous plate has at least one active or passivedampening element attached thereto.